From the Guidelines
Tranexamic acid (TXA) should not be used as a standard treatment to stop a gastrointestinal (GI) bleed, due to the lack of clear evidence on its benefits and potential harms [ 1, 1 ].
Key Points
- The use of high-dose intravenous TXA is not recommended for critically ill patients with GI bleeding, due to high certainty of harms and no clear benefit [ 1, 1 ].
- There is some evidence suggesting that TXA may reduce mortality in acute GI bleeding, but this benefit is not consistently seen in all studies and the quality of evidence is limited [ 1 ].
- The optimal dosing regimen for TXA in GI bleeding is unclear, and more research is needed to determine its potential role as an adjunctive treatment [ 1 ].
- Low-dose or enteral TXA may be considered in specific cases, but the evidence is currently insufficient to support its routine use [ 1, 1 ].
Considerations
- The decision to use TXA in GI bleeding should be made on a case-by-case basis, taking into account the individual patient's risk factors and the potential benefits and harms of treatment [ 1, 1 ].
- Further research is needed to fully understand the effects of TXA on patient-important outcomes in GI bleeding, including mortality, functional recovery, and potential harms such as thromboembolic events [ 1 ].
From the Research
Tranexamic Acid (TXA) and Gastrointestinal (GI) Bleeding
- TXA is not effective in reducing bleeding in upper and lower gastrointestinal bleeding, as stated in the study 2.
- The study 2 highlights that TXA has well-documented beneficial effects in many clinical indications, but its use in GI bleeding is not supported by the evidence.
- There is no mention of TXA being effective in stopping GI bleeds in the other studies 3, 4, 5, 6, which focus on its use in trauma, surgical bleeding, and bleeding disorders.
TXA Administration and Bleeding Control
- TXA has been shown to reduce mortality in patients suffering from trauma and postpartum hemorrhage, as stated in the study 2.
- The study 6 suggests that prehospital TXA administration may reduce early all-cause mortality in adult trauma patients when given within three hours of injury.
- However, the effectiveness of TXA in controlling GI bleeding is not supported by the available evidence, as stated in the study 2.
Safety and Adverse Effects
- The study 2 notes that TXA can cause harm, such as an increased risk of seizures after high TXA doses with brain injury and cardiac surgery, and an increased mortality after delayed administration of TXA for trauma events or postpartum hemorrhage.
- The study 3 found that patients receiving TXA had higher rates of venous thromboembolic events, which is a potential adverse effect of TXA administration.
- The study 4 found no significant differences in the number of thromboembolic events recorded between patients who received TXA and those who did not.